The assessment of serum lipid and lipoprotein levels is a common procedure which affects the management of the risk of atherothrombotic cardiovascular disease (CVD) in large numbers of patients. Traditionally, this led to interpretive comments based on fasting levels of total and HDL cholesterol and calculated or direct measurement of LDL cholesterol (LDL-C). Recent developments have encouraged a broader perspective in which lipid results are considered in the context of other clinical factors. A patient-centred approach favours the consideration of a range of clinical factors, few of which are provided on test request forms. It is increasingly appropriate for lipid results to be discussed in a consultative fashion so that these additional clinical details can be included. Nevertheless, basic lipid results often serve to frame the relevant question and encourage an iterative exchange which might lead to more detailed investigation. Furthermore, new perspectives are emerging concerning the roles of LDL-C, triglyceride, HDL cholesterol and genetic influences. This presentation will consider common scenarios such as predominant hypercholesterolaemia, mixed hyperlipidaemia, massive hypertriglyceridaemia, primary genetic dyslipidaemia and secondary dyslipidaemia. Clinical and therapeutic contexts such as secondary prevention and statin intolerance will also be discussed.